OBJECT: A series of 306 consecutive patients with an anterior communicating artery (ACoA) aneurysm is presented. The goal in this study was to report the results of endovascular treatment of ACoA aneurysms in these patients. METHODS: The aneurysms were managed with an endovascular approach in which detachable coils were used. A brief anatomical description of the ACoA and its branches as well as a review of the surgical and endovascular literature is presented. The "ACoA Syndrome" (that is, amnesia and personality changes), which may occur after subarachnoid hemorrhage, is briefly reviewed and described. Recent technical developments that can lead to improved results are also discussed. RESULTS: Of the 306 aneurysms, 268 (87.5%) were small, 30 (10%) were large, and 8 (2.6%) were giant. One hundred ninety-three aneurysms (63%) had a small neck, whereas 113 (37%) had a wide neck. Sixty-five lesions (21%) were incidental, 5 (2%) presented with symptoms of mass effect, and 236 (77%) presented with a subarachnoid hemorrhage. A complete aneurysm occlusion was attained in 139 cases (45.5%), a neck remnant was detected in 145 (47.5%), and in 22 cases (7%) a residual filling of the aneurysm was observed. Regarding the clinical neurological outcome, 280 patients (91.5%) remained neurologically intact, improved, or unchanged from their initial clinical status. Two large, wide-necked, subtotally occluded aneurysms ruptured 3-7 months after the procedure, with subsequent death of the patients. The procedure-related morbidity and mortality rates were 3.5% (11 cases) and 1% (3 cases), respectively. CONCLUSIONS: The inherently lower risk of injuring or occluding the delicate branches and perforating vessels arising from the ACoA makes the endovascular approach attractive, interesting, and elegant.
OBJECT: A series of 306 consecutive patients with an anterior communicating artery (ACoA) aneurysm is presented. The goal in this study was to report the results of endovascular treatment of ACoA aneurysms in these patients. METHODS: The aneurysms were managed with an endovascular approach in which detachable coils were used. A brief anatomical description of the ACoA and its branches as well as a review of the surgical and endovascular literature is presented. The "ACoA Syndrome" (that is, amnesia and personality changes), which may occur after subarachnoid hemorrhage, is briefly reviewed and described. Recent technical developments that can lead to improved results are also discussed. RESULTS: Of the 306 aneurysms, 268 (87.5%) were small, 30 (10%) were large, and 8 (2.6%) were giant. One hundred ninety-three aneurysms (63%) had a small neck, whereas 113 (37%) had a wide neck. Sixty-five lesions (21%) were incidental, 5 (2%) presented with symptoms of mass effect, and 236 (77%) presented with a subarachnoid hemorrhage. A complete aneurysm occlusion was attained in 139 cases (45.5%), a neck remnant was detected in 145 (47.5%), and in 22 cases (7%) a residual filling of the aneurysm was observed. Regarding the clinical neurological outcome, 280 patients (91.5%) remained neurologically intact, improved, or unchanged from their initial clinical status. Two large, wide-necked, subtotally occluded aneurysms ruptured 3-7 months after the procedure, with subsequent death of the patients. The procedure-related morbidity and mortality rates were 3.5% (11 cases) and 1% (3 cases), respectively. CONCLUSIONS: The inherently lower risk of injuring or occluding the delicate branches and perforating vessels arising from the ACoA makes the endovascular approach attractive, interesting, and elegant.
Authors: Ahmad Sweid; Kareem El Naamani; Rawad Abbas; Robert M Starke; Khodr Badih; Rayan El Hajjar; Hassan Saad; Bassel Hammoud; Carrie Andrews; Sage P Rahm; Elias Atallah; Sunidhi Ramesh; Stavropoula Tjoumakaris; M Reid Gooch; Nabeel Herial; David Hasan; Robert H Rosenwasser; Pascal Jabbour Journal: Neurosurgery Date: 2022-05-01 Impact factor: 5.315
Authors: Paweł Brzegowy; Iwona Kucybała; Kamil Krupa; Bartłomiej Łasocha; Aleksander Wilk; Paweł Latacz; Andrzej Urbanik; Tadeusz J Popiela Journal: Wideochir Inne Tech Maloinwazyjne Date: 2019-01-21 Impact factor: 1.195